Trandolapril is a prodrug that turns into an active form in the liver, so special care must be taken in patients with impaired function.
In patients with uncomplicated arterial hypertension after the first dose of trandolapril, and also after its increase, the development of arterial hypotension accompanied by clinical symptoms was noted.The risk of developing hypotension is higher in patients who have a deficiency of fluid and salt, resulting from prolonged diuretic therapy, limiting salt intake, dialysis, diarrhea, or vomiting. In such patients, before starting therapy with trandolapril, diuretic therapy should be discontinued and the volume of circulating blood and / or salt content should be replenished.
In the treatment of ACE inhibitors, cases of agranulocytosis and bone marrow suppression have been described. These undesirable phenomena are more common in disorders of kidney function, especially in patients with diffuse connective tissue diseases. In such patients (for example, in systemic lupus erythematosus or systemic scleroderma), it is advisable to regularly monitor the number of leukocytes in the blood and the protein content in the urine, especially if the kidney function is impaired and treated with glucocorticosteroids and antimetabolites.
The use of trandolapril can cause angioedema, swelling of the face, limbs, tongue, throat and / or larynx.
In some patients receiving diuretics (especially recently), after the appointment of trandolapril, a sharp drop in blood pressure is observed.
In case of severe renal insufficiency, a dose reduction of trandolapril may be required; kidney function should be carefully monitored.
In patients with renal insufficiency, chronic heart failure, bilateral stenosis of the renal arteries or unilateral stenosis of the artery of a single functioning kidney, the risk of worsening kidney function is increased. In some patients, arterial hypertension without kidney disease with the appointment of trandolapril in combination with a diuretic may increase blood urea nitrogen and serum creatinine levels. Proteinuria may occur.
In patients with arterial hypertension with concomitant renal dysfunction with the use of trandolapril, hyperkalemia may occur.
With surgical interventions or general anesthesia using drugs that cause arterial hypotension, trandolapril can block the secondary formation of angiotensin II associated with compensatory release of renin.
When using high-permeable polyacrylonitrile membranes during hemodialysis in patients receiving ACE inhibitors, anaphylactoid reactions were described.The use of such membranes should be avoided in the administration of ACE inhibitors to patients on hemodialysis.
The safety and effectiveness of the use of trandolapril in children has not been studied, so its use in children is not recommended.
Impact on the ability to drive vehicles and manage mechanisms.
Based on the pharmacological properties of trandolapril, the ability to drive vehicles or work with complex equipment should not change. However, in some patients with simultaneous intake of alcoholic beverages, especially at the initial stages of treatment with ACE inhibitors or when replacing one drug with another, an increase in the level of ethanol in the blood can be observed and its elimination can be slowed down. As a result, the effects of alcohol can increase. Therefore, with simultaneous reception with alcohol, after the first intake or with a significant increase in the dose of trandolapril for several hours, it is not recommended to drive vehicles or work with mechanisms.